Rural health access for all

Friday

Community Health Centers are a vital resource for northeast Oklahoma by offering care to everyone regardless of an ability to pay or insurance status meaning greater access to preventative services, chronic disease management, oral health, and behavioral health.

AFTON – Community Health Centers (CHC) had their start over 50 years ago when community health activists came together on a national level to form a new healthcare model targeting specific barriers faced by underserved rural and urban communities to establish neighborhood clinics.

Since then, expansion of the federally-supported health center system has grown to over 1,400 organizations providing affordable health care options for more than 27 million people, according to the National Association of Community Health Centers.

According to the Oklahoma Primary Care Association, CHCs are community-based and patient-directed organizations that serve local populations in high-need areas identified by the federal government as having limited physicians, higher than average infant mortality, and elevated poverty.

CHCs primarily operate as federally qualified health centers with their organizations receiving grants under Section 330 of the Public Health Service Act. This qualifies them for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. As such, federally qualified health centers must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.

By offering care to everyone regardless of an ability to pay or insurance status, CHCs provide greater access to preventative services, chronic disease management, oral health, and behavioral health to improve the quality and longevity of the communities they serve.

Building Local Healthcare Access

Among the over 1,400 CHC organizations representing more than 9,800 service sites in the U.S., more than 55 percent are in rural communities, among them, clinics in Afton, Grove, and Welch facilitated by Community Health Center of Northeast Oklahoma, Inc. (CHCNEO).

In 2009, several area community leaders determined there was a need to establish a local clinic to provide primary care to the uninsured, underinsured, Medicaid and Medicare patients residing in the Craig, Delaware and Ottawa County region.

After an initial petition for federal grant funding for a local CHC was denied, efforts continued with additional grant applications and a board of directors was established instituting corporate bylaws and applying to the state to become incorporated as a 501(c)3 nonprofit corporation.

A third grant application was finally approved in 2014 paving the way for the opening of CHCNEO's first clinic in Afton in March of the same year then named the Route 66 Health Clinic with health services under the supervision of Dr. William Durick.

Since then, CHCNEO has established two additional CHCs, one in Grove and one in Welch.

In 2016 the CHCNEO Board of Directors approved a request by CHCNEO CEO Patrick Peer to establish the Grove Community Health Center at 10405 US Highway 59 with Durick moving his practice to Grove and later joined by Russell Peters, APRN-CNP.

In July 2016 of the same year, a business decision was made by St. Francis Hospitals to close their clinic location in Welch and an offer was extended to CHCNEO administration to lease the site at 343 S. Commercial St.

The CHCNEO Board of Directors approved the request to establish the Welch site and in October 2017, after receiving authorization from the federal government, the Welch Community Health Center began operation.

The reopening of the Welch facility under CHCNEO also allowed clients in northern Craig and Ottawa counties to continue receiving care under the supervision of Family Medicine Physician Assistant Billy R. Evans who has practiced at the clinic location for over 20 years.

Since reopening under CHCNEO the Welch clinic has also extended its service hours from three days a week, two of which were half days, to 8 a.m. to 5 p.m., Monday through Friday to meet the needs of the community.

2017 also saw the relocation of the Afton Community Health Center into a new facility at 21965 Bison Drive just off Highway 59, west of the Miller Pecan Company. The new care center provides a site that is more accessible and has five treatment rooms and a larger lab while maintaining the culture of the former site and the primary care facility supported by Melinda Bailey, ARNP.

“We are excited about the new locations, building, and services and look forward to continuing our quest to provide the finest quality healthcare to the folks in northeast Oklahoma,” said Peer, “We will be developing plans to expand to other rural locations in 2018 and years to come. Community based primary health care is what we do and what we do well and will remain the focus of our mission, vision, and values.”

On the horizon is a CHCNEO clinic in Vinita once funding is in place.

"Our business plan that was developed a couple years ago really focused on the next expansion being into Vinita, primarily because of a lack of physicians and providers there who are taking or are able to take Sooner Care and Medicare," said Peer. "We've met a couple times with the City Manager and the Mayor who are excited about the opportunity and us moving there. Of course, its dependent on funding, so that's what we are trying to come up with now, the monies that we need to find a space, hire staff, and move in. We hope by the end of summer to have some kind of presence in Vinita."

There are a lot of hurdles in securing the funding needed for new clinics such as state budget restraints along with delays in the approval of ongoing federal funding for CHCs.

Peer also explained that on top of the already significant expenses of setting up a new clinic, such as acquiring a property and setting up exam rooms and equipment, CHCNEO must also contend with current state law that requires him to contract or hire a physician for oversight of clinical staff at a new location.

"Some of our existing law requires physician oversight for our allied health providers - nurse practitioners and physician assistants. With the current law as it is now with nurse practitioners not being allowed to be independent providers means I would have to contract or hire another physician before I could put another nurse practitioner or PA into Vinita. That's a couple hundred thousand dollars."

In the meantime, Peer said CHCNEO remains persistent in exploring all funding opportunities through local and federal grants and its commitment to future expansion into communities in need.

CHCNEO has also expanded its community reach with a new website, www.chcneo.com, and a social media presence on Facebook, Twitter, Instagram, and YouTube sharing health resources and clinic information.

A Collaborative Plan

CHCs generate $24 million in savings to the healthcare system annually by managing and treating chronic disease, curbing the costly use of emergency rooms for primary care, and avoiding unnecessary hospitalizations according to a recent multistate study published in the American Journal of Public Health.

Peer said on the local level he is currently engaged in establishing a collaborative initiative between CHCNEO and local hospitals to implement structures that prevent visits to emergency rooms for primary care services and referral and treatment options for follow-up care.

"It's very expensive when patients use the emergency room for primary care," said Peer. "There is increased emphasis now from Washington and the Department of Health and Human Services to keep patients out of the emergency rooms for primary care and to avoid readmissions within 30 days."

A CHCNEO partnership with local hospitals would encompass community outreach to inform patients of regional CHCs and their accessibility and a process for setting up follow-up treatment at CHCNEO clinics to avoid readmissions.

"As an example, if we have a patient of ours who is admitted into the hospital, upon their discharge or before their discharge having their discharge planner contact us to schedule an appointment with one of our clinics within 24 hours so we can avoid that readmission back into the hospital. So it's a real collaborative effort that we are going to try and undertake."

Bridging Mental, Physical Health

CHCNEO has also recently introduced on-site behavioral health counseling at its Afton clinic in support of the three-county region with the hiring of Licensed Clinical Social Worker Diane Vinson.

Vinson offers general behavioral health counseling and treatment with an emphasis on reducing dependency on opioid medications and adolescent counseling.

Peer said while there has always been a desire to provide behavioral health services through CHCNEO funding for primary care was too limited to make it possible.

Then in 2017, an opportunity presented itself through a grant from the Department of Health and Human Services to provide funding to hire a Licensed Clinical Social Worker or Medical Social Worker to assist with the treatment of opioid addiction.

"We applied for the grant and we got it, and as I was sitting at my desk trying to figure out how I was going to be able to compete and hire someone of Diane's caliber, I got a call from another FQHC (federally qualified health center) where she was working and letting me know she was relocating and wanting to know if we had an opening," said Peer. "After I picked myself up off of the floor I was put in touch with Diane and we talked and I actually hired her over the phone."

Vinson's marriage into a family in the area is what prompted her relocation from Lawton and she joined CHCNEO to provide counseling services in late 2017.

Inspired by her mother, a now-retired social worker who worked within the child welfare system, Vinson pursued a career in social work herself. She holds a background in substance abuse treatment and before joining CHCNEO in Afton was working with adolescents through the state.

Vinson said her transition to northeast Oklahoma has been a very good one and she has already started seeing some clients.

"It's been very, very good. I feel like I have gotten the chance to get acclimated to the place, and all the other workers have been very accessible for questions and helping me learn not just about the facility but about the area and dynamics and the culture," said Vinson.

Patients come to Vinson through the CHCNEO referral system or through self-referrals, and after an intake interview, so she can assess their needs, she creates a treatment plan.

"This is a relatively new process where we are incorporating behavioral health into primary care. In the past, it was kind of like the separation of church and state and it was very difficult in a lot of instances to be able to get someone referred into behavioral health," said Peer. "There were so many different avenues that had to be pursued based on insurance and other requirements, so now that we have someone on staff patients can do something like self-refer, it's a really good integration."

Peer added that an integrated approach will also serve as a means of overcoming the stigma often associated with behavioral health counseling and patients following through on treatment.

"We're in the developing stages, but our process would be that if a nurse practitioner or physician feels that a patient could benefit from interaction with Diane, rather than writing out a referral they could contact her while the patient is here," said Peer. "She could go into the exam room before the patient leaves to introduce herself and establish a rapport and schedule a follow-up appointment right then and there."

Serving Community

Beyond the clinical services side, CHCNEO is also dedicated to serving the community in other areas by providing free support services such as its Outreach and Enrollment program that has been successful at helping many beneficiaries obtain healthcare insurance through the government’s Marketplace and into state-sponsored programs such as SoonerCare and Insure Oklahoma.

For more information about CHCNEO and its services or to schedule an appointment, visit www.chcneo.com or call the Afton Community Health Center at 918-257-8029, the Grove Community Health Center at 918-801-7504 or the Welch Community Health Center at 918-788-3918.

Dorothy Ballard is the managing news editor of the Miami News-Record. Email her at dballard@miaminewsrecord.com and follow her on Twitter @dm_ballard.